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What level of hospital capacity is needed to respond to outbreaks of severe coronavirus disease 2019 in US cities, and how is this associated with intervention timing?
In this comparative effectiveness study, higher inpatient and intensive care unit utilization in Wuhan was compared with lower utilization in Guangzhou, which implemented strict social distancing measures as well as contact tracing and quarantine protocols earlier than Wuhan. The projected number of prevalent critically ill patients at the peak of a Wuhan-like outbreak in US cities was estimated to range from 2.2 to 4.4 per 10 000 adults, depending on differences in age distribution and comorbidity (ie, hypertension) prevalence.
The findings of this study suggest that strict disease control strategies should be implemented early to mitigate the demand for inpatient and intensive care unit beds during a coronavirus disease 2019 outbreak.
Sustained spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has happened in major US cities. Capacity needs in cities in China could inform the planning of local health care resources.
To describe and compare the intensive care unit (ICU) and inpatient bed needs for patients with coronavirus disease 2019 (COVID-19) in 2 cities in China to estimate the peak ICU bed needs in US cities if an outbreak equivalent to that in Wuhan occurs.
Design, Setting, and Participants
This comparative effectiveness study analyzed the confirmed cases of COVID-19 in Wuhan and Guangzhou, China, from January 10 to February 29, 2020.
Timing of disease control measures relative to timing of SARS-CoV-2 community spread.
Main Outcomes and Measures
Number of critical and severe patient–days and peak number of patients with critical and severe illness during the study period.
In Wuhan, strict disease control measures were implemented 6 weeks after sustained local transmission of SARS-CoV-2. Between January 10 and February 29, 2020, patients with COVID-19 accounted for a median (interquartile range) of 429 (25-1143) patients in the ICU and 1521 (111-7202) inpatients with serious illness each day. During the epidemic peak, 19 425 patients (24.5 per 10 000 adults) were hospitalized, 9689 (12.2 per 10 000 adults) were considered in serious condition, and 2087 (2.6 per 10 000 adults) needed critical care per day. In Guangzhou, strict disease control measures were implemented within 1 week of case importation. Between January 24 and February 29, COVID-19 accounted for a median (interquartile range) of 9 (7-12) patients in the ICU and 17 (15-26) inpatients with serious illness each day. During the epidemic peak, 15 patients were in critical condition and 38 were classified as having serious illness. The projected number of prevalent critically ill patients at the peak of a Wuhan-like outbreak in US cities was estimated to range from 2.2 to 4.4 per 10 000 adults, depending on differences in age distribution and comorbidity (ie, hypertension) prevalence.
Conclusions and Relevance
Even after the lockdown of Wuhan on January 23, the number of patients with serious COVID-19 illness continued to rise, exceeding local hospitalization and ICU capacities for at least a month. Plans are urgently needed to mitigate the consequences of COVID-19 outbreaks on the local health care systems in US cities.
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Accepted for Publication: April 12, 2020.
Published: May 6, 2020. doi:10.1001/jamanetworkopen.2020.8297
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Li R et al. JAMA Network Open.
Corresponding Author: Ruoran Li, MPhil, Harvard T.H. Chan School of Public Health, Center for Communicable Disease Dynamics, Department of Epidemiology, 677 Huntington Ave, Boston, MA 02115 (firstname.lastname@example.org).
Author Contributions: Ms Li had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Li, Rivers, Toner, Lipsitch.
Acquisition, analysis, or interpretation of data: Li, Tan, Murray, Toner.
Drafting of the manuscript: Li.
Critical revision of the manuscript for important intellectual content: Rivers, Tan, Murray, Toner, Lipsitch.
Statistical analysis: Li, Tan.
Obtained funding: Murray, Lipsitch.
Administrative, technical, or material support: Rivers, Tan.
Supervision: Murray, Toner, Lipsitch.
Conflict of Interest Disclosures: Ms Li reported receiving grants from Harvard University outside the submitted work. Dr Lipsitch reported personal fees from Merck outside the submitted work. No other disclosures were reported.
Funding/Support: Dr Lipsitch was supported by award number U54GM088558 from the National Institute of General Medical Sciences, award number CK000538-01 from the Centers for Disease Control and Prevention co-op agreement, and a gift from the Morris-Singer Fund.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the official views of the National Institute of General Medical Sciences, the National Institutes of Health, or the Centers for Disease Control and Prevention.
Additional Contributions: We thank the entire Center for Communicable Disease Dynamics team for providing a supportive environment for this work. Helen Jenkins, PhD (Boston University), provided critical feedback on data visualization. She was not compensated for her time. Ms Li thanks her fellow doctoral students for their support.
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